GOP should switch from repealing the ACA to improving it

After years of railing against the Affordable Care Act, it’s a wonder the Republican-controlled Congress didn’t declare Jan. 31 a national holiday. That was the closing day for open enrollment in ACA insurance plans and supposedly the closing bell for the historic law itself.

Now, after their many fruitless attempts to repeal the health care law, Republicans in Congress have a president who will sign its fate. But their tone has changed abruptly. The GOP mantra of “repeal and replace” has been subtly but significantly changed – on the advice of a pollster – to simply “repair.”

“It is more accurate to say ‘repair Obamacare,’ ” Sen. Lamar Alexander, R-Tenn., chairman of the Senate health committee, said this week. “We can repair the individual market, and that is a good place to start.”

Behind the change

What has happened is that Republicans have brought the ACA to the brink, but now realize they may go over with it. There are several reasons for this change of perspective.

First is that there isn’t any substance behind the term “replace.” Republicans simply don’t have a workable plan and can’t see a way to write one that doesn’t throw millions of people off their insurance, cut the ACA’s most appealing aspects or lead to higher deductibles or premiums.

Second, as Paul Waldman noted in The Washington Post on Friday, Republicans are virtually alone in their opposition to the ACA. They harp on the ACA passing without a single Republican vote, but that party line vote masked a great deal of bipartisan cooperation and consultation in developing the complex legislation. The ACA is, after all, modeled on a Republican idea. It preserves the role of private insurance companies and President Obama agreed to leave out an element favored by liberals, the public option, or “Medicare for all.”

The ACA isn’t some left-wing, socialized medicine program. It is a plan developed by committee with all the compromises – and inefficiencies – that entails. But through that process it gained the support of the American Medical Association, which historically opposed all government interventions in health insurance, the AARP, hospital associations and drug companies. None of those groups is now eager to have the plan dismantled and replaced with a less effective and much narrower approach that would result in fewer Americans having access to health care.

Finally, the ACA works. Enrollment has been strong and 20 million more Americans have gained health insurance because of it. The law did not, as Republicans predicted, “kill jobs.” Its costs have come in under estimates. Its cost-control provisions appear to be bending down the rise in health care costs. Medicaid expansion has given peace of mind and better health to millions of low-income Americans. Indeed, actual experience with the law has helped Americans see through Republicans’ “train wreck” negativity about the ACA. An NBC/Wall Street Journal poll in January found that for the first time, more people support the law than oppose it.

A cooler approach

Like any large plan with so many parts, the ACA needs fixes. Even its strongest supporters concede that. But with Republicans in Congress previously so rabid to repeal it, the law could never be safely opened on the House floor for repairs without the risk of the whole law being thrown out. That danger may now be fading. Much of the Republican fervor against the law was directed at its author – Barack Obama. Now that he’s out of office, the fever may be breaking in the same way that Hillary Clinton’s defeat has killed Republicans’ once relentless interest in Benghazi or their desire to “lock her up.”

Beyond its link to Obama, Republicans also dislike the law because it imposes taxes on wealthy people to help middle- and low-income people. But given the windfall in tax cuts the wealthy and corporations are likely to get on other fronts from a Republican-led Congress and a Republican president, the ACA taxes may become easier to tolerate.

Now that Republicans have full control, they should get about making the ACA work better for everyone. That means expanding Medicaid in the holdout states, setting up more state exchanges that have less bureaucracy than the federal exchange and providing support for insurance companies that will foster more competition and consumer options.

As President Obama might say, “If you like your health care law, you should be able to keep it.”

This story was originally published February 4, 2017 at 7:15 PM with the headline "GOP should switch from repealing the ACA to improving it."